Scenarios around exclusions when setting up integrations

Why 

If a patient who is in prison is sent details of their forthcoming appointments and letters via Patients Know Best (PKB) then these appointments and letters could potentially be seen /shared with their friends and family. This could happen either because these friends/family are added as carers in the prisoner’s PKB record or because the prisoner sees the appointment date/time and shares it with them outside of PKB. This constitutes a potential risk to the prisoner, any health or social care staff involved in the appointment and the public if unauthorised individuals turn up to the appointment and intercept the prisoner after accessing this data.

PKB strongly supports NHSE guidance that hospitals stop sending appointment information and letters into PKB when patients are known to be in prison/detained.

What

Generally, PKB strongly encourages sending as much patient data as possible via our APIs. However, there are specific circumstances, such as when a patient is known to be a prisoner, when it is appropriate to limit what is sent to a patient's record. The action to limit what is sent needs to be undertaken by the Organisation/hospital because PKB does not have the ability to identify if a PKB record belongs to a prisoner or not.  

At the point of the organisation being notified that a patient is a prisoner, this is when the Organisation should begin filtering out relevant HL7 messages that are sent to PKB for that patient record.

How

PKB will process the data that is sent in via our APIs from the organisations integrating with us, this data is then added to patient records in line with the scope of our APIs and the associated data model. In a situation where a patient is being detained in prison, PKB does not specifically identify these records and therefore the development and application of any related data filtering or exclusions needs to be undertaken by the sending organisation to ensure it is excluded at source. 

It is crucial to address situations involving patients that are currently detained in prison but precisely how the sending organisation manages the identification and subsequent exclusion of data relating to these patient records is a matter for them. However, from PKB’s experience of working with a wide range of organisations, it is common for organisations to implement an exclusion process by utilising functionality within the Organisation Integration Engine (TIE). This usually involves applying a real-time lookup on the patient record address (e.g. Postcode or key term match such as H.M.P) that identifies patient records of individuals in detention, then restricting the messages transmitted to PKB through our APIs when a match is found.

PKB does recognise that organisations often face challenges specific to their own circumstances when it comes to the ability to develop and apply such logic.  Our Integrations team is therefore available to provide support and advice as and when necessary to aid in the identification of an appropriate and workable solution.

If an Organisation uses a hybrid mail provider for appointment letters this exclusion rule can usually be applied by them. 

Freezing Records

If for any reason an organisation does not feel that it is sufficient in a particular case to restrict the sending of appointments and letters to a prisoner’s PKB record and would like to restrict the prisoner’s access to the record entirely then the ‘Freeze Record’ feature is an option. In PKB, an organisation can freeze a patient's record at any time, which prevents the patient and any carers in the record from being able to log in and access the data within. 

This can be achieved by a professional logging into the organisation’s ‘Patient Records Team’ and navigating to the patient’s summary page where the ‘Freeze Record’ button can be found. An email notification will not be sent to the patient or their carers to tell them that the record has been frozen. When the patient tries to log in, or when the carer tries to access the record, they will be shown a message on the login screen stating that the record is unavailable. The record can be ‘unfrozen' just as easily at any time by following the same process.

Wayfinder 

It is important to realise that excluding prisoners from appointment feeds is a requirement for Wayfinder compliance.